中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (7): 527-531. doi: 10.3969/j.issn.1672-6731.2021.07.001

• 专论 • 上一篇    下一篇

2 大脑前动脉搭桥术在复杂前交通动脉瘤中的应用

佟小光, 王轩   

  1. 300350 天津市环湖医院神经外科 天津市神经外科研究所显微神经外科实验室 天津市脑血管与神经变性重点实验室
  • 收稿日期:2021-07-19 出版日期:2021-07-25 发布日期:2021-07-26
  • 通讯作者: 王轩,Email:osen1984@hotmail.com
  • 基金资助:

    天津市科技计划项目(项目编号:18ZXDBSY00180)

Cerebral revascularization for anterior cerebral artery applied in surgery of the complex anterior communicating artery aneurysms

TONG Xiao-guang, WANG Xuan   

  1. Department of Neurosurgery, Tianjin Huanhu Hospital;Laboratory of Microneurosurgery, Tianjin Neurosurgical Institute;Tianjin Key Laboratory of Cerebral Vascular and Neural Degenerative Diseases, Tianjin 300350, China
  • Received:2021-07-19 Online:2021-07-25 Published:2021-07-26
  • Supported by:

    This study was supported by Tianjin Science and Technology Plan Commission (No. 18ZXDBSY00180).

摘要:

大脑前动脉搭桥术是治疗前交通动脉瘤的重要方法,根治动脉瘤的同时应保证大脑前动脉灌注区的血供。大脑前动脉搭桥术旨在重建前交通动脉功能,情况复杂,手术难度大。在血运结构上,前交通动脉作为Willis环的前部枢纽,远离颞浅动脉和颈外动脉等常规供体动脉,血管重建方案在受体动脉方面需兼顾双侧血管,与血管搭桥术密切相关的前交通动脉复合体存在诸多变异;在手术操作上,前交通动脉位置深在,术野狭小,属于深部搭桥,同时因额叶的遮挡,供血区和受血区同时显露受到限制,动脉瘤体较大时更增加显露难度。基于上述血流动力学和血管结构的复杂性,以及随着手术入路向颅底扩展形成的各种颅内搭桥新路径,本文对大脑前动脉搭桥术在前交通动脉瘤中的特点、血管重建方案的创新设计和手术入路的选择进行综述。

关键词: 大脑前动脉, 脑血管重建术, 前交通动脉瘤(非MeSH词), 综述

Abstract:

The bypass surgery for anterior communicating artery (ACoA) aneurysms is a considerable option for the radical treatment of complex ACoA aneurysms and maintaining the perfusion of anterior cerebral artery (ACA) territories. The bypass modalities with the aim to rebuild the function of ACoA are complicated and technically challenging. For vascular architecture, the ACoA as the anterior pivot of the circle of Willis is remotely situated to traditional donor vessels, while bilateral efferent arteries should be treated as recipient vessels, and the anatomical variability of ACoA complex further complicate these situations. For surgical application, the working corridor is deep and narrow, so bypass procedure necessitates deep anastomosis. Thus the traditional surgical exposure requires two separate approaches to access the proximal afferent and distal efferent arteries for vascular control and anastomosis. In this article, we review the available innovative modifications that designed in order to create individualized strategies for each patient because of the complexity of hemodynamics and the vascular architecture.

Key words: Anterior cerebral artery, Cerebral revascularization, Anterior communicating artery aneurysm (not in MeSH), Review